Disasters Happen: What Does Your Medicare Contractor Want You to Do Next?

Fri, Oct 21, 2016


medical billing when disaster strikes

I’m feeling pretty lucky. When Hurricane Matthew blew through my town a couple of weeks ago, the worst I experienced was a three-day power outage and a flooded basement. Plenty of others nearby faced much worse. My town is several hours from the coast, so the degree of destruction took most of us by surprise, proving that you can’t make assumptions about when a natural disaster will strike.

Once my power (and therefore Internet) returned, I noticed emails from different payers with alerts about how Hurricane Matthew was affecting claims and advice on what to do. These emails were a good reminder that medical practices need to have preparations in place so they have a plan to follow when emergencies occur.

Improve Your Post-Disaster Know-How With These FCSO Tips

First Coast Service Options (FCSO) added a page in its Disaster Information section for its Florida Medicare providers that offers tips on handling issues presented by Hurricane Matthew. If you aren’t under FCSO, you can still get some good advice and get motivated to check out what your own payers have to say about handling claims after a disaster.

Temp address: If you can’t get mail at your usual location, you can set up a temporary address for payments from FCSO to go to. Your disaster preparation plan can include keeping a record of options for your alternate address and the contact information (such as payer phone number) required to set up the temporary change. Keep your plan in a safe place (or places) that you can get to when you need it.

Paper claims: FCSO also reveals some good news and bad news about swapping to paper claims. Good: HIPAA regulations allow paper claims when natural disaster strikes. Not as good: FCSO reminds its providers that payment for paper claims won’t be as speedy as electronic claim payment. Instead of issuing payment in 14 days, FCSO says you can expect clean paper claims to be paid more than 27 days after FCSO gets the claim. So if you expect to be able to submit electronic claims within about a week of the natural disaster, you may want to just hold on to any claims until then.

Appeal extension: When it comes to any appeals you have pending, you may be glad to know that FCSO says you can claim hurricane recovery as a reason to ask for a time extension.

Records: If you got hit so hard that you lost medical records, FCSO advises reconstructing what you can for any partially destroyed records. You do need to mark the face of the record with this note, though: “This record was reconstructed because of disaster.”

Review These Resources Before It’s Too Late

If you participate in Medicare, be sure to check out the emergency Q&A docs provided by CMS about policies and procedures that apply without a waiver and those that require a waiver to be granted.

And, speaking of waivers, if you’ve been wondering when to use modifier CR (Catastrophe/disaster related), be sure to read MLN Matters MM7156 about the limited circumstances that make use of this modifier appropriate. You should append it only when Medicare payment relies on the presence of a formal waiver.

How About You?

Do you have any disaster prep tips to share? Have you found that payers work with you to handle issues that come up when disaster strikes?

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Will CPT® 2017 Settle Drug-Screen Coding Once and For All?

Tue, Oct 18, 2016


drug screen CPT 2017 update

Coding for drug screening certainly keeps you sharp. Along with all the CPT® codes and rules, you’ve got to remember that Medicare requires use of a separate set of HCPCS codes in 2016. But you may find things a little simpler in 2017.

Add CPT® Codes That Are HCPCS Lookalikes

CPT® 2017 deletes presumptive drug class screening codes 80300-80304. A note in CPT® 2017 says to look instead to new codes 80305-80307.

The new codes’ descriptors look almost identical to the HCPCS codes Medicare required you to use in 2016, G0477-G0479. The plan is to delete the HCPCS codes and use the CPT® codes for Medicare.

For the Clinical Lab Fee Schedule (CLFS), the expectation is that the pricing for the new 2017 codes will be similar to the pricing of their 2016 HCPCS counterparts.

You’ll want to check HCPCS 2017 and the final CLFS when they’re released to be sure all of these proposals get finalized, of course.

Here’s a rundown of the new codes. Note that just like the HCPCS codes you’ve been using, the CPT® descriptors specify that:

  • The codes include sample validation (such as pH, specific gravity, and nitrite) if performed
  • The codes apply once per date of service.

Apply 80305 for Direct Optical Observation

When the analyst visually reads the results of the test, you’ll use 80305 (Drug test[s], presumptive, any number of drug classes, any number of devices or procedures [e.g., immunoassay]; capable of being read by direct optical observation only [e.g., dipsticks, cups, cards, cartridges] includes sample validation when performed, per date of service).

Code 80305 replaces G0477.

Choose 80306 for Instrument Assist

When the analyst uses an instrument to help determine the results of a direct optical observation test, then you’ll report 80306 (… read by instrument assisted direct optical observation [e.g., dipsticks, cups, cards, cartridges], includes sample validation when performed, per date of service).

So, for example, if the analyst inserts a dipstick into an instrument to get the final result, you’ll use 80306.

This code resembles current code G0478.

Select 80307 for Instrumented Chemistry Analyzer

The final code in the new group is appropriate when the analyst uses any of a large number of methods requiring instrument chemistry analyzers. The code is 80307 (Drug test[s], presumptive, any number of drug classes, any number of devices or procedures, by instrument chemistry analyzers [e.g., utilizing immunoassay (e.g., EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA)], chromatography [e.g., GC, HPLC], and mass spectrometry either with or without chromatography, [e.g., DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF] includes sample validation when performed, per date of service).

Code 80307 is modeled on G0479, but the list of examples is more extensive in 80307’s descriptor.

The CPT® guidelines explain that some of the methodologies listed in the example are also in use for definitive drug testing. The presumptive method, however, does not definitively identify the drug.

Here’s Where You’ll Find the New Codes

In your CPT® manual, you’ll notice that the presumptive Drug Class Screening and Definitive Drug Testing codes continue to remain out of numerical order in the lab section of CPT®. Each code is marked with # to indicate the code is placed in the section based on the nature of the service rather than being in numerical order.

The codes come after Organ or Disease-Oriented Panels code 80076 and before Therapeutic Drug Assays code 80150.

How About You?

Are you a lab coder? Do you think these changes will finally bring some stability to coding for drug screening?

For in-depth, expert analysis of the changes coming for this unique specialty, be sure to check out Pathology/Lab Coding Alert, included in SuperCoder’s Pathology/Lab Coder.

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Rule Change: If You’ve Never Reported Moderate Sedation Before, Read This

Fri, Oct 14, 2016

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cpt 2017 moderate sedation reporting change

It’s time to start adjusting your brain to the new reality about moderate sedation coding. For years, you’ve trained yourself to not report your provider’s moderate sedation separately when CPT® marked the procedure code with a circle with a center dot symbol and listed the code in Appendix G.

But the 2017 Medicare Physician Fee Schedule and CPT® 2017 want to change all that. CPT® 2017 removes the symbol from more than 400 codes, and that means you need to report the moderate sedation code if you want to be paid for it.

Codes for vascular procedures, electrophysiology, and gastroenterology procedures dominate the list of codes that carried the moderate sedation symbol in 2016 and before, so if you code for those services, you need to pay particular attention to the changes coming for moderate sedation.

Focus on Age and Time to Find Right Codes

In addition to changing the rules for reporting moderate sedation, CPT® changes the codes, too. CPT® 2017 deletes current moderate sedation codes 99143-+99150. The replacement codes are similar to the old codes (with some variations in time requirements), but if you never used the old codes, that news doesn’t help you much.

You’ll choose from these 2017 codes when a physician or other health care professional provides the moderate sedation for a procedure she’s performing herself (bold added):

  • 99151, Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
  • 99152, … initial 15 minutes of intraservice time, patient age 5 years or older
  • +99153, … each additional 15 minutes intraservice time (List separately in addition to code for primary service).

Key points: Code 99151 applies to the first 15 minutes of moderate sedation services for a patient younger than five. If the patient is five or older, use 99152 for the first 15 minutes. Code +99153 applies to each additional 15 minutes regardless of patient age.

Worth noting: Additional new codes 99155, 99156, and +99157 look a lot like 99151-+99153 but apply when someone other than the surgical provider performs the moderate sedation services.

Here’s Proof Reviewing the Proposed MPFS Is Helpful

The proposed 2017 Medicare Physician Fee Schedule provides insights into why the change is happening. The short version is that Medicare factored payment for moderate sedation into procedure codes with the moderate sedation symbol. Medicare has noticed anesthesia getting reported separately for scope procedures with the moderate sedation symbol and didn’t want to pay for both the anesthesia performed and the moderate sedation not performed.

After considering different options, like removing the symbol from only certain codes, the decision was to streamline and have providers report and get paid for moderate sedation only when they perform it.

What does this mean to you? If you report any services listed in AMA’s CPT® 2016 Appendix G, you’ve got some work to do. You need to review the new codes, read the guidelines, and ensure that your documentation clearly documents everything you need to support reporting the new codes. The plan is to reduce RVUs for those Appendix G codes because moderate sedation will no longer be included, so reporting moderate sedation when appropriate is crucial to your goal of bringing in every dollar you deserve.

Gastro coders beware: Keep an eye on HCPCS 2017. You can expect to use a new G code for Medicare claims instead of 99152 to better reflect the work involved:

Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service (excluding biliary procedures) that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older.

Watch private payer policies to see if they accept the new G code, too.

How About You?

Are you ready to start reporting moderate sedation? Are you concerned about the RVUs changes?


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Q&A to Decode the OPPS 2017 Proposed Rule Site Neutral Payments Provision

Mon, Oct 10, 2016

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OPPS 2017 Q&A

Off-campus outpatient departments have an eye on CMS’s Hospital Outpatient Prospective Payment System (OPPS) changes for 2017. You can review highlights of the proposed rule here”, and you’ll see that one of the more interesting proposals has to do with who isn’t invited to the OPPS party under the site neutral payments provision.

Section 603 of the Bipartisan Budget Act of 2015 affects how Medicare pays certain off-campus outpatient departments, called provider-based departments or PBDs. The idea is that certain items and services a PBD provides will be paid under a payment system other than OPPS starting Jan. 1, 2017.

Q1: What payment system will CMS use instead of OPPS?

A1: For 2017, CMS proposes to use the Medicare Physician Fee Schedule (MPFS) as the payment system for most of the items and services not paid under OPPS based on the site neutral payments provision. Physicians furnishing the services can expect to see payment rates based on the professional at the nonfacility MPFS rate.

The plan is to use the MPFS for a year while CMS considers options for a different Part B payment system to use for off-campus PBDs.

Q2: In the proposal, which off-campus PBDs, items, and services are excepted from the payment changes?

CMS proposes to allow certain off-campus PBDs to bill for specified items and services under OPPS. Items and services furnished in these specific sites are excepted, meaning CMS plans to continue to pay them under OPPS:

  • Items and services furnished in a dedicated emergency department
  • Items and services furnished and billed by an off-campus PBD before Nov. 2, 2015.
  • Items and services furnished in a hospital department that is within 250 yards of the hospital’s remote location.

Q3: Does the Nov. 2015 exception mean our PBD can be grandfathered in?

Sort of. Your legal and compliance departments should take a close look at the proposed (and, of course, final) rule to understand all the ins and outs.

For example, the CMS proposed rule states that while those items and services you furnished before Nov. 2, 2015, will be excepted (paid under OPPS), new items and services that don’t fall in the same clinical families as what you’ve historically offered will not be excepted services.

You’ll encounter limitations if there is a change of ownership for the hospital, too. You may remain an excepted PBD if the new owners accept the existing Medicare provider agreement.

Your team also should be aware that moving physical location will cause you to lose excepted status. If your PBD is facing a relocation that’s beyond the hospital’s control, submit a comment to CMS. They’re requesting comments to be sure they’ve considered factors like that.

What About You?

Do you see a need for this rule? How are you preparing for the change?

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CPT® 2017: 5 Fast Facts to Master New Angioplasty Codes

Fri, Oct 7, 2016


CPT 2017 transluminal balloon angioplasty coding

Veteran vascular coders have watched CPT® change their coding options year after year from component codes (separating out each element of a procedure) into more comprehensive codes. One of the targets in CPT® 2017 is transluminal balloon angioplasty. Get up to speed on proper use of these new codes with these quick tips.

1. Keep Artery and Vein Options Separate

The first two new angioplasty codes represent artery services (bold added):

  • 37246, Transluminal balloon angioplasty (except lower extremity artery[ies] for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
  • +37247, … each additional artery (List separately in addition to code for primary procedure).

You’ll have two other new codes that apply to vein services (bold added):

  • 37248, Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein
  • +37249, … each additional vein (List separately in addition to code for primary procedure).

2. Don’t Report Related S&I Separately

The code descriptors state that the codes include “all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same” vessel.

That means that instead of the component code approach of reporting one code for the angioplasty and another code for the radiological supervision and interpretation (S&I), the new codes take a more comprehensive approach, bundling both aspects into the same code.

3. Apply Same Codes to Open and Percutaneous

These new codes, 37246 to +37249, apply regardless of whether the procedure is open or percutaneous. This update is in line with other changes CPT® has made to vascular codes in recent years, such as endovascular revascularization codes 37220 to 37239. Those codes also apply to both open (larger incision with visualization) or percutaneous (minimally invasive through the skin).

4. Remember Add-On for Each Additional Vessel

When you reviewed the descriptors for the new codes, did you catch that you have different options for initial and additional vessels?

Apply 37246 to the initial artery and then add +37247 for each additional artery treated in the same session.

The vein codes follow a similar structure with 37248 for the initial vein and +37249 for each additional vein.

5. Look Elsewhere to Code Exceptions

One of the trickier aspects of the new codes is that the descriptors tell you only which vessels the codes do NOT apply, not which vessels the new codes do apply to.

In both the artery and vein code descriptors you’ll see that the codes are not appropriate for angioplasty in the dialysis circuit, which CPT® 2017 adds some other new codes for.

The artery descriptors also exclude services on the lower extremity arteries for occlusive disease and intracranial, coronary, and pulmonary artery services.

Bottom line: Use your CPT® Index and read the coding guidelines to be sure you’ve chosen the appropriate code for the patient’s case.

What About You?

Are you new to coding angioplasty or have you been rolling with the changes through the years? Do you prefer component codes or a more all-in-one approach?

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Get Up to Date With a 2017 Quick Guide to EVAT Coding

Tue, Oct 4, 2016


CPT 2017 endovenous ablation codes

All you coders who report percutaneous endovenous ablation therapy (EVAT) can expect some interesting code changes in CPT® 2017.

Meet the New Mechanochemical Option

The big news is two new codes for mechanochemical ablation:

  • 36473, Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated
  • +36474, … subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure).

These new codes follow the same format as existing codes 36475 and +36476 for radiofrequency ablation and 36478 and +36479 for laser ablation. The codes are for percutaneous services and include all imaging guidance and monitoring.

Adjust Add-On Descriptors

Eagle-eyed veterans may have noticed that the wording for +36474 varies a tiny bit from the 2016 descriptors for +36476 and +36479.

In 2016, the add-on codes end this way: … second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure).

In 2017, +36476 and +36479 get a descriptor tune-up so they will end the same way +36474 does: … subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure).

The codes apply to one or more additional veins (after the first) treated through a distinct access site.

Anticipate CCI Edits

Take time to check Correct Coding Initiative (CCI) edits before reporting these codes. CCI version 22.2 added some edits involving EVAT codes. The edits prevent you from reporting the add-on code for one modality with the codes for a different modality.

Example: CCI bundles +36479 for laser ablation of subsequent veins into 36475, the code for radiofrequency ablation of a first vein. The edit has a modifier indicator of 0, so you can’t override the edit with a modifier.

When the next version of CCI comes out for the Jan. 1, 2017, implementation, it’s possible we’ll see similar edits for the new mechanochemical ablation codes, preventing you from reporting different modalities together.

Dig Deeper by Reviewing LCD

Payers have detailed rules about EVAT coverage, so be sure to review your local payer policy and watch for updates incorporating the new codes.

Typical policies require documentation that conservative therapies, like wearing compression stockings, did not work for the patient.

What About You?

Do you code EVAT services? Are you excited about your new code options, or are there other updates you’re looking forward to using?

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Coding Debridement Using 11042 to +11047? Let’s Do Some Math!

Fri, Sep 30, 2016


calculating for debridement codes

There’s a theme to the Correct Coding Initiative (CCI) edits going into effect Oct. 1, 2016. Debridement codes, including 11042 to +11047, are getting bundled into surgical code after surgical code. (Check out the changes file for physicians/practitioners here under Related Links, and watch for cases where existing edits swap the columns the codes are in.) But there are times when reporting these codes is the correct thing to do, and that’s our focus today.

Applying debridement codes from 11042 to +11047 requires counting wounds, counting centimeters, and counting layers … but you have to do it all while ignoring what you know about counting because these codes are out of order. Confused? Let me explain.

Start With the Resequenced Debridement Codes

In the CPT® manual, the code order for 11042-+11047 is not what you’d expect. Instead, you’ll find that the add-on codes are “resequenced” codes, meaning ones that CPT® added and put out of proper order to avoid having to renumber an existing section. Here’s how you’ll find the codes ordered in CPT®:

  • 11042, Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
  • +11045, … each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
  • 11043, Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
  • +11046, … each additional 20 sq cm, or part thereof
  • 11044, Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
  • +11047, … each additional 20 sq cm, or part thereof

By adding these codes out of order, CPT® was able to add “each additional 20 sq cm” options directly after the related debridement code for the first 20 sq cm.

Look for Layers Involved in Debridement

When you review the code descriptors, you can see that the layer the debridement reaches is a key part of choosing the correct code:

  • 11042, +11045: Subcutaneous tissue
  • 11043, +11046: Muscle and/or fascia
  • 11044, +11047: Bone.

As CPT® guidelines state, you code based on the depth of tissue removed. So check for depth of debridement, rather than depth of wound. When coding a single wound debrided to different depths, choose your code based on the deepest level reached. CPT® guidelines back you up on that.

Learn the Simple Centimeter Rule

In addition to knowing the depth, you need to know the surface area involved. You’ll choose a primary code (11042, 11043, or 11044 based on depth) to represent the first 20 sq cm. If the wound is 20 sq cm or less, then you report just the primary code. But if the wound is greater than 20 sq cm, you should report an add-on code (+11045, +11046, or +11047, again based on depth) for each additional area up to 20 sq cm.

You may report a single add-on code multiple times, but you may find payers limit the number of times you may report the code. For example, the medically unlikely edit (MUE) for +11047 is 4.

Handle Multiple Wounds With Ease

The math gets a little tricky when you encounter coding for multiple wounds debrided on the same date of service, but you just need to know when to code wounds together and when to code them separately.

When you’re coding multiple wounds, check for all wounds debrided at the same depth, such as all those that reach only the subcutaneous tissue. Then sum together the surface area of the wounds and code the same as you would for a single wound using the primary and add-on codes that apply to that depth.

If different wounds reach different depths, then you should code those independently.

Example: Consider this scenario:

  • 5 sq cm ischial ulcer, bone debridement
  • 16 sq cm thigh wound, subcutaneous debridement.

Report 11042 for the thigh wound and 11044 for the ischial ulcer. CCI edits bundle 11042 into 11044, so you should append a modifier to 11042 to override the edit.

How About You?

Do you see a lot of debridement coding? Do you find the rules and definitions confusing? What’s your opinion of resequenced codes?

ICD-10 Reminder

Tomorrow is the big day for ICD-10 2017 starting and the CMS grace period ending. Be sure you start using the new code set and Official Guidelines for dates of service Oct. 1, 2016, and later. (And discussions are well underway for the next round of updates.)


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3 Helpful Z Code Hints Every Eye Care Coder Should Know

Tue, Sep 27, 2016


Z codes

Poor ICD-10 Z codes. All the way at the end of the code list and often overlooked. They don’t even get the attention W codes do for interesting adventures involving turtles.

But Z codes do have an important role to play, and today we’re going to show them some love. Let’s look at what these codes have to offer for optometry and ophthalmology services.

1. Know When to Use Routine and Admin Exam Codes

Z codes are in Chapter 21, Factors Influencing Health Status and Contact With Health Services. As the chapter name implies, the codes indicate the reason for an encounter. For eye care, be sure you get to know these codes for routine and administrative examinations:

  • Z01.00, Encounter for examination of eyes and vision without abnormal findings
  • Z01.01, Encounter for examination of eyes and vision with abnormal findings
  • Z02.4, Encounter for examination for driving license.

OG tips: The ICD-10 Official Guidelines (OGs) explain that you should not use these codes if the exam “is for diagnosis of a suspected condition or for treatment purposes.” Use the appropriate diagnosis code in those cases.

The OGs list Z00 and Z01 as categories you may report only as the principal/first-listed diagnosis unless the patient has more than one encounter on that date with combined medical records.

If the provider discovers a condition during the exam, you should report that as an additional code (such as in addition to Z01.01). Choose your codes based on what you know at the time you’re coding. For instance, you can report Z01.00 for no abnormal findings even if test results aren’t in yet.

2. Support Treatment Decisions With Z Codes

Smart coders know when to use Z codes to help tell the story of the patient encounter.

Example: An ophthalmologist spends extra time examining a patient with a history of gestational diabetes during multiple pregnancies. You use Z86.32 (Personal history of gestational diabetes) as an additional diagnosis code to explain the higher level service provided to check for any indications of retinopathy.

Z codes don’t guarantee coverage by any means, but the reality is accurate, compliant coding doesn’t always guarantee coverage.

Just remember to select Z codes based on what’s relevant to the current encounter and what affects patient management.

3. Don’t Double Up on Transplant Codes

You’ll find status codes starting with Z, too, like, Z94.7 (Corneal transplant status). But if you’re reporting another ICD-10 code that refers to the transplant status, you should not report the Z status code, according to both the OGs and an Excludes1 note with category Z94.-.

Example: If you’re reporting a code from subcategory T86.84- (Complications of corneal transplant), you should not also report Z94.7. The T86.84- codes make it clear that the patient has a corneal transplant, so using Z94.7 adds no information to the claim.

How About You?

When do you use Z codes? Have you encountered any problems using these codes? How do you remember to use these codes correctly?

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Discs, GISTs, and Cysts: Look for Location in ICD-10 2017

Fri, Sep 23, 2016


ICD10 2017 site specificity

Are you seeing a theme in blog posts lately? ICD-10 2017! We’ve got just one more week until the new code set goes into effect, so cram time is here. Today we’ll set our sights on three areas that radiology coders may be using soon. The common thread for these code changes is that your 2017 options require you to have a better idea of the specific site involved than the 2016 counterparts required.

Match Mid-Cervical Disc Disorder Code to Level

Watch out for new site requirements for mid-cervical disc disorder codes. (I mentioned this for orthopedic coders, too, but it’s worth repeating.)

Under ICD-10 2017, you’ll need to add a sixth character to identify the level for these subcategories:

  • M50.02-, Cervical disc disorder with myelopathy, mid-cervical region
  • M50.12-, Cervical disc disorder with radiculopathy, mid-cervical region
  • M50.22-, Other cervical disc displacement, mid-cervical region
  • M50.32-, Other cervical disc degeneration, mid-cervical region
  • M50.82-, Other cervical disc disorders, mid-cervical region
  • M50.92-, Cervical disc disorder, unspecified, mid-cervical region.

Your sixth character options for the 2017 codes are below:

  • 0, unspecified level
  • 1, at C4-C5 level
  • 2, at C5-C6 level
  • 3, at C6-C7 level.

Where in the GI Is the GIST?

ICD-10 2016 kept it simple but vague for coding a malignant gastrointestinal stromal tumor (GIST). The Index pointed you to C49.4 (Malignant neoplasm of connective and soft tissue of abdomen).

In 2017, you’ll be using all new, four-character codes specific to GISTs. The codes require you to identify the location of the GIST:

  • C49.A0, Gastrointestinal stromal tumor, unspecified site
  • C49.A1, Gastrointestinal stromal tumor of esophagus
  • C49.A2, Gastrointestinal stromal tumor of stomach
  • C49.A3, Gastrointestinal stromal tumor of small intestine
  • C49.A4, Gastrointestinal stromal tumor of large intestine
  • C49.A5, Gastrointestinal stromal tumor of rectum
  • C49.A9, Gastrointestinal stromal tumor of other sites.

ID Which Ovary and Fallopian Tube for Category N83

In 2017, code options related to cysts, atrophy, prolapse and hernia, and torsion of the ovaries and fallopian tubes will expand to identify the side.

Caution: To create complete codes in category N83, you sometimes need five characters and sometimes need six. And whether you use a 0 or 9 to represent “unspecified side” depends upon the number of characters. If that’s hard to picture, just take a look at the codes below.

Complete at 5 Characters

  • N83.0-, Follicular cyst of ovary
  • N83.1-, Corpus luteum cyst
  • N83.4-, Prolapse and hernia of ovary and fallopian tube

Use these fifth character options:

  • 0, unspecified side
  • 1, right
  • 2, left

Complete at 6 Characters

  • N83.20-, Unspecified ovarian cysts
  • N83.29-, Other ovarian cysts
  • N83.31-, Acquired atrophy of ovary
  • N83.32-, Acquired atrophy of fallopian tube
  • N83.33-, Acquired atrophy of ovary and fallopian tube
  • N83.51-, Torsion of ovary and ovarian pedicle
  • N83.52-, Torsion of fallopian tube

Use these sixth character options:

  • 1, right
  • 2, left
  • 9, unspecified side

What Do You Think?

Radiology coders have a tough task because they code for conditions that affect the entire body, and the nature of ordering and imaging can lead to limited documentation to work with. Do you predict any issues with these new codes?

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